CD68-positive tumour associated macrophages, PD-L1 expression, and EBV latent infection in a high HIV-prevalent South African cohort of Hodgkin lymphoma patients.

A higher proportion of CD68-positive tumour associated macrophages (TAMs) has been associated with poorer outcomes in HIV-negative patients with Hodgkin lymphoma (HL), but whether this is true in HIV-positive patients with HL is not known. In this study, we investigated the number of CD68-positive TAMs and expression of programmed cell death-ligand 1 (PD-L1) in lymph node specimens from HL patients and correlated expression with clinical features (HIV status, disease severity and survival) and histopathological features (EBV latent positivity and subtype of HL). We stained archived lymph node specimens from 77 patients diagnosed with HL for CD68 and PD-L1. Stains were graded as: CD68 low (≤25%), CD68 high (>25%), PD-L1 low (≤50%), and PD-L1 high (>50%). Expression levels were correlated with the clinical and histopathological features using bivariate and multivariate analyses. Survival was analysed by overall and progression-free survival. Thirty-four of the 77 included patients (44%) were HIV-positive. EBV latency was detected in 97% of HIV-positive HL patients and in 14% of HIV-negative HL patients. A high CD68 score was associated with lower median haemoglobin levels (9.4 vs 11.4 g/dL; p=0.02), platelet numbers (262 vs 424 cells ×109/L; p=0.01), and lymphocyte numbers (0.99 vs 1.70 cells ×109/L, p=0.01) and a trend towards advanced disease (international prognostic score ≥4; hazard ratio 2.4; confidence interval 0.89-6.47; p=0.08). HIV status did not affect CD68 or PD-L1 expression. A higher proportion of CD68-positive TAMs was found in samples that were EBV-positive. HIV positivity and EBV negativity correlated with poorer survival. CD68 and PD-L1 expression were not predictive of survival. High CD68 expression was associated with EBV positivity but not HIV positivity and did not predict adverse outcomes. PD-L1 expression was unaffected by HIV status or EBV positivity and did predict adverse outcomes.

Evolution of mutualistic behaviour between Chlorella sorokiniana and Saccharomyces cerevisiae within a synthetic environment.

Yeast and microalgae are microorganisms with widely diverging physiological and biotechnological properties. Accordingly, their fields of applications diverge: yeasts are primarily applied in processes related to fermentation, while microalgae are used for the production of high-value metabolites and green technologies such as carbon capture. Heterotrophic-autotrophic systems and synthetic ecology approaches have been proposed as tools to achieve stable combinations of such evolutionarily unrelated species. We describe an entirely novel synthetic ecology-based approach to evolve co-operative behaviour between winery wastewater isolates of the yeast Saccharomyces cerevisiae and microalga Chlorella sorokiniana. The data show that biomass production and mutualistic growth improved when co-evolved yeast and microalgae strains were paired together. Combinations of co-evolved strains displayed a range of phenotypes, including differences in amino acid profiles. Taken together, the results demonstrate that biotic selection pressures can lead to improved mutualistic growth phenotypes over relatively short time periods.

Laryngeal Chondrosarcoma: A rare cause of critical upper airway obstruction.

Laryngeal cancers are rare, encompassing around one percent of all cancers. Suspicion should be raised if a patient presents with classical signs and symptoms; i.e. dysphonia, inspiratory stridor, dysphagia, odynophagia, neck mass, or persistent cough. Laryngeal chondrosarcoma is a rare form of laryngeal cancer, the diagnosis of which can be difficult. The case in question describes an unusual presentation of one such case, and its subsequent investigation, management and outcome.

Is treatment de-escalation a reality in HPV related oropharyngeal cancer?

The incidence of HPV related oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing. It is now well recognised as a distinct clinical and biologic entity, compared to traditional OPSCC. The majority of these patients have an excellent prognosis due to the chemo-radiosensitive nature of these tumours. The de-escalation of current treatment regimens have therefore been proposed in an attempt to reduce the long term treatment related morbidity of this much younger patient cohort. Several of the more pertinent points regarding safe de-escalation strategies are considered within this manuscript.

Paediatric tonsillotomy--an Irish perspective on potential evolving indications.

Tonsillotomy is the preferred treatment of some otolaryngologists for younger patients (under 3 years) with low body weight (under 15 kgs) and a history of obstructive sleep apnoea. The use of the technique in the same patient cohort for recurrent tonsillitis remains controversial. The aim of this study was to evaluate the indications and outcomes of paediatric patients undergoing tonsillotomy (with or without adenoidectomy) at a paediatric ENT centre in Ireland. Patients were identified from a prospectively maintained database and chart review was completed. A total of 23 patients were identified who underwent tonsillotomy. The commonest indication was Obstructive Sleep Apnoea (OSA) in 15 patients (65%). Outcomes following tonsillotomy compared favourably with traditional tonsillectomy. No intra-operative or post-operative complications were recorded (0%). No patients required readmission or later tonsillectomy (0%). At follow-up 19/23 patients with OSA (82.6%) had complete symptom resolution. Tonsillotomy appears to represent a safe, effective treatment option in the paediatric population, however, its role in recurrent tonsillitis remains controversial.

General practitioner ENT referral audit.

BACKGROUND: During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services. AIMS: To determine the compliance rate of general practitioners with the ICGP referral guidelines. METHODS: One-hundred referrals received were compared to the ICGP standardised form and graded accordingly. Each referral letter was graded to a maximum of 37 points. RESULTS: The average score recorded for referrals was 16/37. The referrer detail section scored the highest with a mean of 75.42 % (paediatric referrals) and 72.9 % (adult referrals). The clinical information provided demonstrated compliance rates of 34 % (paediatrics) and 35 % (adults). In total, only 32 letters made any reference to findings on examination. Both paediatric and adult referrals scored an average of 42 % when patients' details are considered. CONCLUSION: This study demonstrates poor compliance rates with the introduced ICGP standardised referral form, which has implications for the accurate grading of referral letters received.

Trans-cervical, trans-tracheal approach to proximal tracheo-oesophageal fistula: a novel technique.

Esophageal atresia and tracheo-esophageal fistula (TEF) occur in 1/2400-4500 births. Whilst the diagnosis of esophageal atresia is readily made shortly after birth, patients with an isolated H type TEF can present with varying degrees of symptomatology which can pose a diagnostic challenge. A combination of contrast esophagogram and endoscopic evaluastion is the most commonly employed localization strategy. Despite accurate pre-operative localization, intra-operative identification of the TEF can prove substantially more challenging. The authors of this report describe a novel approach in the management of a proximal TEF, which allows direct visualization and cannulation via a trans-cervical, trans-tracheal approach.

A case of quinsy following high-pressure water jet injury.

High-pressure water injuries of the oropharynx are uncommon but can cause significant injury and airway compromise when they occur. A small number of cases of high-pressure water injury of the oropharynx have been presented in the literature, detailing a range of effects and outcomes. We describe the first reported case of high-pressure water injury of the oropharynx associated with peritonsillar abscess (quinsy) requiring surgical drainage.

Alternatives to the impact factor.

OBJECTIVE: To explore alternative bibliometric markers to the well-established journal impact factor. The bibliometric evolution of a leading ENT journal over a six year period is discussed with critical analysis of a predetermined set of bibliometric alternatives to the journal impact factor. DESIGN: Retrospective review of the bibliometric performance of Clinical Otolaryngology over a six year period. RESULTS: The results of the study reveal that Clinical Otolaryngology has made steady bibliometric progress when the impact factor (IF) is considered with a gradual increase in impact factor from 1.098 in 2006 to a peak of 2.393 in 2011. Self-citation rates reported by the Journal Citation Report (JCR) demonstrated a significant decline during 2007 with a reported self-citation rate of 0%. The SCImago Journal Rank (SJR) database however recorded a self-citation rate of 67. Independent evaluation demonstrated a 56 self-citations during this period. The percentage of review articles published remained stable during the period in question. A lagged association between the number of review manuscripts and the IF failed to demonstrate any significant correlation (r = -0.19). Comparison between the IF and the Eigen factor (EF) as well as the SJR yielded negative correlation (r = -0.46) and (r = -0.35) respectively. The Article Influence score (AIS) and Source Normalised Impact per Paper (SNIP) were the only bibliometric alternatives to demonstrate a positive correlation when compared to the IF (r = 0.94) and (r = 0.66) respectively. CONCLUSIONS: The necessity of bibliometric markers cannot be called into question however the most widely employed of these, the journal impact factor has come under increased scrutiny of late. Despite some of the advantages offered by novel bibliometric markers, these do not necessarily compare favourably to the IF with regards to bibliometric performance. The only two markers to demonstrate a positive correlation when compared to the IF were the AI score and SNIP which would suggest that these are potential alternatives to the IF and have the added advantage that they are open access.

Glomangiopericytoma (sinonasal-type haemangiopericytoma).

BACKGROUND: Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours. OBJECTIVE: Discussion of the clinical presentation, histopathological features and advances in the management of sinonasal and skull base glomangiopericytoma. CASE REPORT: A 32-year-old woman presented with worsening nasal obstruction, anosmia, severe frontal headaches and right-sided proptosis. Radiographic and endoscopic examination revealed a right-sided, vascular mass involving the nasal cavity, paranasal sinuses and anterior skull base. Histopathological features were consistent with a glomangiopericytoma. Complete endoscopic resection with free margins was achieved. CONCLUSION: Glomangiopericytomas are rare, vascular, sinonasal tumours. Successful management depends on complete resection, traditionally achieved via an open approach. However, recent advances in endoscopic surgical approaches have enabled complete endoscopic resection of these tumours, minimising morbidity and facilitating subsequent surveillance of the operative site.

The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience.

CONCLUSIONS: These results support the use of a pectoralis major myofascial flap (PMMF) in patients undergoing salvage surgery. BACKGROUND: Pharyngocutaneous fistula (PCF) is the most common major complication following laryngectomy. Preceding chemoradiotherapy increases the incidence and severity of PCF formation. The aim of this study was to determine whether the use of a PMMF reduces the incidence and severity of PCF formation in patients undergoing salvage surgery. METHODS: This was a retrospective cohort analysis. RESULTS: A total of 33 patients were identified, including 10 patients who underwent salvage surgery after chemoradiotherapy. In all, 80% of salvage surgery patients underwent PMMF reinforcement of the pharyngeal closure. A PCF rate of 50% was recorded for salvage surgery patients without PMMF reinforcement. Identical PCF rates (25%) were recorded for patients who underwent primary total laryngectomy and salvage surgery patients treated with PMMF reinforcement. Mean duration to fistula closure was 57.16 days in the primary laryngectomy group compared with 20.5 days in salvage surgery patients with PMMF reinforcement.

The changing face of informed surgical consent.

OBJECTIVES: To determine whether procedure-specific brochures improve patients' pre-operative knowledge, to determine the amount of information expected by patients during the consenting process, and to determine whether the recently proposed 'Request for Treatment' consenting process is viable on a large scale. METHOD: A prospective, questionnaire-based study of 100 patients admitted for selected, elective surgical procedures. RESULTS: In total, 99 per cent of patients were satisfied with the information received in the out-patient department, regarding the proposed procedure. However, 38 per cent were unable to correctly state the nature of the surgery or specific procedure they were scheduled to undergo. Although the vast majority of patients were able to state the intended benefits to be gained from the procedure, only 54 per cent were able to list at least one potential complication, and 80 per cent indicated that they wished to be informed about all potential complications, even if these occurred in less than 1 per cent of cases. CONCLUSIONS: The introduction of procedure-specific brochures improved patients' pre-operative knowledge. Although the failings of current consenting practice are clear, the Request for Treatment consenting process would not appear to be a viable alternative because of the large number of patients unable to accurately recall the nature of the proposed surgery or potential complications, following consent counselling.

Paediatric blunt laryngeal trauma: a review.

Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.

Lymphatic malformations: a proposed management algorithm.

OBJECTIVE: The aim of this study was to develop a management algorithm for cervicofacial lymphatic malformations, based on the authors' experience in managing these lesions as well as current literature on the subject. STUDY DESIGN AND METHODS: A retrospective medical record review of all the patients treated for lymphatic malformations at our institution during a 10-year period (1998-2008) was performed. DATA COLLECTED: age at diagnosis, location and type of lesion, radiologic investigation performed, presenting symptoms, treatment modality used, complications and results achieved. RESULTS: 14 patients were identified. Eight (57%) male and six (43%) female. There was an equal distribution between the left and right sides. The majority (71%) of cases were diagnosed within the first year of life. The majority of lesions were located in the suprahyoid region. The predominant reason for referral was an asymptomatic mass in 7 cases (50%) followed by airway compromise (36%) and dysphagia (14%). Management options employed included: observation, OK-432 injection, surgical excision and laser therapy. In 5 cases (36%) a combination of these were used. CONCLUSION: Historically surgical excision has been the management option of choice for lymphatic malformations. However due to the morbidity and high complication rate associated this is increasingly being questioned. Recent advances in sclerotherapy e.g. OK-432 injection have also shown significant promise. Based on experience in managing these lesions as well as current literature the authors of this paper have developed an algorithm for the management of cervicofacial lymphatic malformations.

The Appropriateness of the South African Thoracic Society's Guidelines for Antibiotic Treatment of Patients with Chronic Obstructive Pulmonary Disease Exacerbation in the Universitas Academic Hospital; Bloemfontein

Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin/ clavulanate; cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital; Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007; not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission; were included. Demographic information (age; gender; area of residence; smoking history) was obtained from patients' files; as well as FEV1 values; FEV1/FVC ratio; infection markers; microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female; with a median age of 72 years (range 53 - 82 years). Twelve (70.6) patients resided in the Bloemfontein urban area. Three patients (18.8) never smoked; 25smoked previously and 56.3were active smokers (median pack years 45 years; range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae; H. parainfluenzae; Streptococcus pneumoniae; Staphylococcus aureus; Pseudomonas aeruginosa; Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus; all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region

Magnitude and contributory factors of postnatal depression: a community-based cohort study from a rural subdistrict of Bangladesh.

BACKGROUND: Recent evidence suggests that the prevalence of postnatal depression (PND) is highest in low-income developing countries. This study aimed to estimate the prevalence of PND and its associated risk factors among Bangladeshi women. METHOD: The study was conducted in the Matlab subdistrict of rural Bangladesh. A cohort of 346 women was followed up from late pregnancy to post-partum. Sociodemographic and other related information on risk factors was collected on structured questionnaires by trained interviewers at 34-35 weeks of pregnancy at the woman's home. A validated local language (Bangla) version of the Edinburgh Postnatal Depression Scale (EPDS-B) was used to measure depression status at 34-35 weeks of pregnancy and at 6-8 weeks after delivery. RESULTS: The prevalence of PND was 22% [95% confidence interval (CI) 17.7-26.7%] at 6-8 weeks post-partum. After adjustment in a multivariate logistic model, PND could be predicted by history of past mental illness [odds ratio (OR) 5.6, 95% CI 1.1-27.3], depression in current pregnancy (OR 6.0, 95% CI 3.0-12.0), perinatal death (OR 14.1, 95% CI 2.5-78.0), poor relationship with mother-in-law (OR 3.6, 95% CI 1.1-11.8) and either the husband or the wife leaving home after a domestic quarrel (OR 4.0, 95% CI 1.6-10.2). CONCLUSIONS: The high prevalence of PND in the study was similar to other countries in the South Asian region. The study findings highlight the need for programme managers and policy makers to allocate resources and develop strategies to address PND in Bangladesh.

The impact of pollution from a mercury processing plant in KwaZulu-Natal, South Africa, on the health of fish-eating communities in the area: an environmental health risk assessment.

The objective of this study was to determine the human health risk associated with fish consumption in a contaminated area downstream from a mercury processing plant in KwaZulu-Natal, South Africa. The study population consisted of fish consumers living in close proximity to the u'Mgeni River and the Inanda Dam downstream from the plant. A control group was selected from the area upstream from the mercury plant as far as the Nagle Dam. Total daily mercury consumption per kilogram body weight per day was calculated for each person included in the study. These data were compared with the tolerable daily intake standard published by the World Health Organization, as well as to the United States Environmental Protection Agency's reference dose. Human hair samples obtained from the study population and a control group were analysed for mercury content. The results of the risk estimation indicated that the study population is at risk. Human hair samples, however, indicated that dangerous levels of mercury had not yet been consumed. Humans in this study area could be subject to an excessive health risk from mercury as a result of their fish consumption. Fish mercury levels in the contaminated area should be monitored closely.